Healthcare Provider Details

I. General information

NPI: 1649008970
Provider Name (Legal Business Name): VERTEX ANESTHESIA ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 MULBERRY ST STE 110
MACON GA
31201-8220
US

IV. Provider business mailing address

577 MULBERRY ST STE 110
MACON GA
31201-8220
US

V. Phone/Fax

Practice location:
  • Phone: 888-728-0882
  • Fax:
Mailing address:
  • Phone: 888-728-0882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateNULL

VIII. Authorized Official

Name: NICOLE NOBLES PAULK
Title or Position: COO
Credential:
Phone: 888-728-0882